Obamacare: have to sign up for plan before coverage starts

When doctors provide free health care to patients who cannot afford to pay and do not have insurance, should the healthcare provider require that the patient sign up for ACA insurance (or Medicare/Medicaid) within X days in lieu of a bill?Inquisitive in Indiana
Dear Inquisitive in Indiana,
Almost no health insurer will sell a person coverage for last month, so this is not a practical way for the doctor to get bills paid. I say “almost no health insurers” because Medicaid regularly pre-dates coverage but only for certain kinds of patients and only in certain circumstances.
Hospitals help patients apply for Medicaid, and in many states, the coverage can be retroactive and cover the hospital bill. For certain types of patients — such as legal immigrants who only get their emergency care covered by Medicaid — this is the most common method of enrolling. They are essentially only enrolled for their emergency room visit.
In addition, a person can only enroll in health insurance during annual open enrollment or when he has had a family status change, such as getting married or divorced. This is called a special enrollment period. Even then, the coverage starts after the application is done, not before.
Lots of clinics, hospitals, and doctors’ offices are helping people sign up for health insurance these days. So it might seem like they are doing that in order to get their bills paid. To some extent, this may be true but they aren’t getting yesterday’s or even today’s bills paid; it is tomorrow’s and next year’s bills.